Coders, like translators, are not allowed to embellish or assume procedures or diagnosis. They are ethically bound to code ONLY what is documented

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Ferdinand Andrews
6 years ago
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3 We will discuss: An introduction to ICD-10 How it impacts staff How an ICD-10-CM code is built What is ICD-10-PCS? How an ICD-10-PCS code is built How ICD-10 will impact documentation and reimbursement What s next?

(reimbursement) Coders, like translators, are not allowed to embellish or

4 Coding is the translation by coding personnel from your documentation into numbers that are submitted to insurance companies for payment for services (reimbursement) Coders, like translators, are not allowed to embellish or assume procedures or diagnosis. They are ethically bound to code ONLY what is documented

On January 15, 2009 the Department of Health and Human Services published a final rule requiring covered entities to comply with the new code set regulations The required compliance date is currently

5 On January 15, 2009 the Department of Health and Human Services published a final rule requiring covered entities to comply with the new code set regulations The required compliance date is currently October 1 st, 2015 ICD-9 was outdated (implemented 35 years ago) It lacked specificity and detail Used terminology inconsistently Could not capture new technology Lacked codes for preventive services ICD-10 more accurately reflects current medical practices: Reimbursement better reflects the intensity of the patient s needs It allows more specificity in information sharing allowing the United States to compare data internationally to track the incidence and spread of disease and treatment outcomes The United States is the only industrialized nation that has not yet implemented ICD-10

Everyone covered by HIPAA: Health care providers who conduct electronic transactions Payers including Medicaid and Medicare Clearinghouses Other healthcare entities that use diagnostic codes will be

6 Everyone covered by HIPAA: Health care providers who conduct electronic transactions Payers including Medicaid and Medicare Clearinghouses Other healthcare entities that use diagnostic codes will be impacted: Vendors and business associates of covered entities Worker s compensation programs Auto insurance companies Life insurance companies Compliance officers, auditors, fraud investigators Utilization and quality management personnel

7 If delayed long enough, ICD-10 will go away H.R.4302 was passed on 4/1/14 delaying ICD-10 implementation until at least 10/1/15. Even though there is a lot of pressure as well as debate to delay, currently the implementation date remains the same. Note: There have been no significant diagnostic updates for ICD-9 since October 1 st, No further updates for ICD-9 were planned. The next update was planned for ICD-10 in There would have to be a major push to be able to try to accommodate ICD-9 with no place to put at least 5 years of new codes into an already overloaded system. Entities such as Worker s Comp and auto insurance companies may choose not to implement ICD-10 ICD-9 will no longer be maintained after ICD-10 is implemented so it is in their best interests to adapt to the new coding system* Lack of definitive diagnosis will affect payment Per CMS: If a definitive diagnosis has not been established by the end of the encounter, it is appropriate to report codes for sign(s) and/or symptom(s) in lieu of a definitive diagnosis** When sufficient clinical information is not known or available about a particular health condition to assign a more specific code, report the appropriate unspecified code** *ICD-10-CM/PCS Myths and Facts, ICN April 2013 **ICD-10-CM Classification Enhancements, ICN April

Identify your current systems and work processes that use ICD-9 Clinical Documentation Encounter forms/superbills Practice management system EHR system

9 Identify your current systems and work processes that use ICD-9 Clinical Documentation Encounter forms/superbills Practice management system EHR system Contracts and reporting protocols Pre-admission/prior authorizations Are your clearinghouses, billing services, and payers prepared for a smooth transition? Talk with your practice management system vendor about accommodations for ICD-10 Assess staff training needs It is recommended that training take place approximately six months prior to the ICD-10 compliance deadline Budget for time and costs related to ICD-10 implementation Training Form revisions

Physician: ICD-10 requires detailed documentation of surgical procedures; more time to document Potential addenda delays for details added to the medical records Office billing/coding work flow

10 Physician: ICD-10 requires detailed documentation of surgical procedures; more time to document Potential addenda delays for details added to the medical records Office billing/coding work flow Increased coding queries directed to physicians for further documentation clarification With the queries, there would be a resulting delay in final coding Prior Authorization/Notification changes Increased complexity/requirements Entire practice: Extensive retraining for physicians, coding and revenue cycle staff Productivity losses should be expected during the initial 3-6 months due to steep learning curve associated with use of ICD- 10-CM/PCS

Coding staff: Will require increased anatomy, diagnostic, and surgical procedure knowledge Potential shortages of experienced, certified coders Learning curve and dual coding in both ICD-9 and ICD-

11 Coding staff: Will require increased anatomy, diagnostic, and surgical procedure knowledge Potential shortages of experienced, certified coders Learning curve and dual coding in both ICD-9 and ICD- 10 for a period of time causing decrease in productivity Potential increase in coding staff to support transition and minimize productivity losses Billing & Reimbursement Accounting Previous data analysis may become obsolete Analysis and trending by payer, changes in coding and data trends may be affected because of the extensive remapping required (i.e. comparing healthcare outcomes from ICD-9 to ICD-10)

12 Payers Some payers may not be ready, able, or willing to take ICD-10 codes May cause denials or delay claim payments Claims may have to be re-coded and re-submitted with ICD-9 codes Just in case, many providers are setting up a line of credit to help them weather the potential reimbursement delays

13 Services before October 1, 2015 need to be completed and processed ASAP to limit disruptions and dual code timeframes Revisions of superbills, encounter forms/ehr templates (to reflect greater specificity) need to be completed Expect increased coder queries

Training Level Staff Example Moderate understanding of ICD-9 to ICD-10 translation Able to interpret ICD-10 s impact on clinical documentation or internal processes Providers Managers Administrative

14 Training Level Staff Example Moderate understanding of ICD-9 to ICD-10 translation Able to interpret ICD-10 s impact on clinical documentation or internal processes Providers Managers Administrative Staff Non-clinical Support Staff Clinical Support Staff Proficient understanding to select and interpret ICD-10 codes Should be able to perform accurate coding tasks and interpret coding rationale Coders Compliance Billers Providers, if self-coding

Payers cannot pay claims fairly using ICD-9-CM The classification does not accurately reflect current terminology Significantly different diagnoses and procedures are assigned to a single ICD-9-CM

15 Payers cannot pay claims fairly using ICD-9-CM The classification does not accurately reflect current terminology Significantly different diagnoses and procedures are assigned to a single ICD-9-CM code These limitations are translating directly into limitations in the DRG groups and therefore, the resulting payments The healthcare industry cannot accurately measure the quality of care using ICD-9-CM There is difficulty evaluating the outcome of new procedures and emerging healthcare conditions when codes are not precise For instance, compare the coding for Ebola: ICD-10 A98.4, Ebola virus disease ICD , Other specified arthropod-borne hemorrhagic fever

International Classification of Diseases (ICD) Maintained by the World Health Organization since 1893 The standard diagnostic tool for epidemiology, health management and clinical purposes.

16 International Classification of Diseases (ICD) Maintained by the World Health Organization since 1893 The standard diagnostic tool for epidemiology, health management and clinical purposes. Translated into 43 languages and 117 countries use the system ICD-10 (10 th revision), which has 12,420 codes is the foundation from which ICD-10-CM was built ICD-10-CM is the Clinical Modification The Clinical Modifications offer a higher level of specificity with more than 68,000 codes is the diagnostic code book to which we will be transitioning The last major code revision was 35 years ago ICD-10-PCS is the Procedural Coding System This new coding system is specific to hospital reporting Note: CPT will continue, unaffected by the ICD-10 transition, to code for outpatient and office procedures as well as professional services

17 Hospital Inpatient Diagnostic Coding ICD-10-CM Facility Procedure Coding ICD-10-PCS Professional Services - CPT Outpatient Diagnostic Coding ICD-10-CM Procedure/Services Coding CPT Products, Supplies, Services, Equipment HCPCS Level II Ambulatory Surgery Center Diagnostic Coding ICD-10-CM Procedure/Services Coding CPT Products, Supplies, Services, Equipment HCPCS Level II

18 General Equivalence Mapping There is no one-to-one mapping from ICD-9 to ICD-10 translating between them the majority of the time can offer only a series of possible compromises rather than the mirror image of one code in the other code set * ICD-9-CM ICD-10-CM Equal Axis of Classification Headache R51 Headache Salmonella meningitis A02.21 Salmonella meningitis Myeloid leukemia, acute, in remission C92.01 Acute myeloid leukemia, in remission Unequal Axis of Classification: Stage of Pregnancy vs. Episode of Care Classified by episode of care: ICD-9-CM Spotting complicating pregnancy, unspecified episode of care Classified by stage of pregnancy: ICD-10-CM O Spotting complicating pregnancy, first trimester Spotting complicating pregnancy, delivered O Spotting complicating pregnancy, second trimester Spotting complicating pregnancy, antepartum O Spotting complicating pregnancy, third trimester O Spotting complicating pregnancy, unspecified trimester *Diagnosis Code Set General Equivalence Mappings, Documentation and User's Guide, CMS

ICD-9 CM ICD-10 CM 3-5 characters 3-7 characters 1st Character = alpha or numeric Characters 2-5 = numeric Approximately 13,000 codes Limited space to add new codes 1st Character = alpha 2nd

Non-specified codification issues: Difficult to analyze data Difficult to support research Allows description of comorbidities, manifestations, etiology/causation, complications, detailed anatomic

19 ICD-9 CM ICD-10 CM 3-5 characters 3-7 characters 1st Character = alpha or numeric Characters 2-5 = numeric Approximately 13,000 codes Limited space to add new codes 1st Character = alpha 2nd Character = numeric 3 rd -7 th Characters = alpha or numeric 7th Character extension = episode of care Approximately 68,000 codes Flexibility to add new codes Lacks detail Lacks laterality Non-specified codification issues: Difficult to analyze data Difficult to support research Allows description of comorbidities, manifestations, etiology/causation, complications, detailed anatomic location, degree of impairment, biologic and chemical agents, phase/stage, lymph node involvement, ICD-10-CM age related, or joint involvement within code choice Very specific, enables laterality to indicate what side of the body is affected: Right side = 1 Left side = 2 Bilateral = 3 Unspecified = 0 or 9 Improved accuracy and richness of codification Allows data comparisons across international boundaries It is estimated that there is only a 5% direct one-to-one matching of codes between ICD-9 and ICD-10

721 Spondylosis and allied disorders M47.81 Spondylosis without myelopathy or radiculopathy 721.0 Cervical spondylosis without myelopathy 721.2 Thoracic spondylosis without myelopathy 721.

811 Spondylosis without myelopathy or radiculopathy, occipito-atlanto-axial region M47.812 Spondylosis without myelopathy or radiculopathy, cervical region M47.

20 721 Spondylosis and allied disorders M47.81 Spondylosis without myelopathy or radiculopathy Cervical spondylosis without myelopathy Thoracic spondylosis without myelopathy Lumbosacral spondylosis without myelopathy Spondylosis of unspecified site Without mention of myelopathy M Spondylosis without myelopathy or radiculopathy, occipito-atlanto-axial region M Spondylosis without myelopathy or radiculopathy, cervical region M Spondylosis without myelopathy or radiculopathy, cervicothoracic region M Spondylosis without myelopathy or radiculopathy, thoracic region M Spondylosis without myelopathy or radiculopathy, thoracolumbar region M Spondylosis without myelopathy or radiculopathy, lumbar region M Spondylosis without myelopathy or radiculopathy, lumbosacral region M Spondylosis without myelopathy or radiculopathy, sacral and sacrococcygeal region M Spondylosis without myelopathy or radiculopathy, site unspecified ICD-9-CM ICD-10-CM

21 ICD-9 One Code ICD Codes (examples of some of the multiple codes below) T82.311A Breakdown (mechanical) of carotid arterial graft (bypass), initial encounter T82.312A Breakdown (mechanical) of femoral arterial graft (bypass), initial encounter T82.329A Displacement of unspecified vascular grafts, initial encounter T82.330A Leakage of aortic (bifurcation) graft (replacement), initial encounter T82.331A Leakage of carotid arterial graft (bypass), initial encounter T82.332A Leakage of femoral arterial graft (bypass), initial encounter T82.524A Displacement of infusion catheter, initial encounter T82.525A Displacement of umbrella device, initial encounter

If it s not documented, it wasn t done Expanded General Documentation Requirements Primary areas of documentation specificity would be: Laterality Defining episode of care (initial vs.

22 If it s not documented, it wasn t done Expanded General Documentation Requirements Primary areas of documentation specificity would be: Laterality Defining episode of care (initial vs. subsequent) Late effects (sequela) Medical Necessity has been and always will be the overarching criterion for payment* The specificity in ICD-10-CM will enhance and support medical necessity for each encounter with fewer request for back-up documentation that would potentially delay reimbursement CMS, Transmittal Rev. 178, 5/14/04

23 The expanded number from approximately 13,000 to approximately 68,000 codes is due to the specificity inherent in each code Example: Open Fracture of distal phalanx of the ring finger ICD-9 = ICD-10 = S Need additional information!: Displaced or non-displaced? 5 th & 6 th characters Right or left hand? Initial or subsequent encounter? If subsequent encounter- Routine or delayed healing? Nonunion or mal-union? 7 th character Late effect (sequela)? So...the better documentation would be an open, nondisplaced fracture of the distal phalanx of the right ring finger, initial encounter = S62.664B (Addition of four words)

24 S52.521A S Chapter 19, Injury, Poisoning and Certain Other Consequences of External Causes S52 Fracture of forearm S52.5 Fracture of lower end of radius S52.52 Torus fracture of lower end of radius S Torus fracture of lower end of right radius S52.521A Torus fracture of lower end of right radius, initial encounter for closed fracture In the above example: S52 is the chapter and the category The fourth and fifth characters of 5 and 2 provide additional clinical detail and anatomic site The sixth character in this example indicates laterality, i.e., right radius The seventh character, A, is an extension that provides additional information, which means initial encounter for closed fracture

25 Let s take, for example, a traumatic forearm fracture ICD-9 47 potential codes ICD potential codes (does not include in that count the 7 th character choices) More detailed information is needed Example: Diagnosis is a Forearm Fracture For ICD-10, Diagnosis will need to answer: Which bone of the forearm? What specific anatomical portion of that bone? What kind of fracture? Right or Left? Displaced or non-displaced? Closed or Open The episode of care? Initial, subsequent, or sequela Any additional comorbid conditions or complications influencing care

26 Location - Forearm Type of Fracture Displaced or Nondisplaced Laterality Episode of Care / Open or Closed Ulna unspecified Torus Displaced Right A - Initial encounter for closed fracture Ulna upper end Greenstick Nondisplaced Left Olecranon process w/o intraarticular extension Olecranon process w/ intraarticular extension Coronoid process Shaft of Ulna Lower end of ulna Ulna styloid process Radius unspecified Transverse Oblique Spiral Comminuted Segmental Monteggia Bent Bone Unspecified B - Initial encounter for open fracture type I or II (or open NOS or not otherwise specified) C - Initial encounter for open fracture type IIIA, IIIB, or IIIC D - Subsequent encounter for closed fracture with routine healing E - Subsequent encounter for open fracture type I or II with routine healing F - Subsequent encounter for open fracture type IIIA, IIIB, or IIIC with routine healing G - Subsequent encounter for fracture with delayed healing H - Subsequent encounter for open fracture type I or II with delayed healing J - Subsequent encounter for open fracture type IIIA, IIIB, or IIIC with delayed healing Radius upper end Galeazzi K - Subsequent encounter for fracture with nonunion Head of Radius Neck of Radius Colles Smith s M - Subsequent encounter for open fracture type I or II with nonunion N - Subsequent encounter for open fracture type IIIA, IIIB, or IIIC with nonunion Shaft of Radius Barton s P - Subsequent encounter for fracture with malunion Lower end of radius Radial styloid process Unspecified fracture of forearm Extraarticular Intraarticular Q - Subsequent encounter for open fracture type I or II with malunion R - Subsequent encounter for open fracture type IIIA, IIIB, or IIIC with malunion S - Sequela

27 More Detailed Coding Requires More Specific Documentation

28 Coding has to make sense to receive payment for the services performed Medical necessity demonstrated by the diagnosis code supports the need for treatment. It answers the question Why, why is the patient being seen TODAY? Examples: An abdominal wound would not support the need for an ORIF of a femur A simple forearm fracture diagnosis would not necessarily support the need for a 10 hour surgery with anesthesia CAD alone does not explain a return to surgery for a sternal rewiring following a CABG In the above examples, the best case scenario would be a request for medical records for medical review with the resulting delay in reimbursement Illogical codes cause denials Your diagnosis must logically answer the question, why is the patient receiving this treatment or procedure?

$Specialty Documentation Obstetrics Trimester must be indicated Orthopedics Detailed anatomical location Specify type of injury (type of fracture, etc.$ ) Emergency and Orthopedics Traumatic Open Fracture codes based on Gustilo Open Fracture Classification Glasgow Coma Scale now a component for coding Oncology In ICD-10, additional

) Emergency and Orthopedics Traumatic Open Fracture codes based on Gustilo Open Fracture Classification Glasgow Coma Scale now a component for coding Oncology In ICD-10, additional

30 Specialty Documentation Obstetrics Trimester must be indicated Orthopedics Detailed anatomical location Specify type of injury (type of fracture, etc.) Displaced/nondisplaced Laterality Phase of healing (routine healing, delayed, non-union, etc.) Emergency and Orthopedics Traumatic Open Fracture codes based on Gustilo Open Fracture Classification Glasgow Coma Scale now a component for coding Oncology In ICD-10, additional qualifiers for code specificity are added to include: Location Laterality Stage Pathology Estrogen receptor status Metastasis Reason for/focus of treatment Complications Anesthesiology Increasing emphasis on coordinating and detailing diagnosis for procedures being performed Documentation regarding conditions that would impact care

31 Documentation of Complications of Care Code assignment is based on the provider s documentation of the relationship between the condition and the care or procedure The guideline extends to any complications of care Note: Not all conditions that occur during or following medical care or surgery are classified as complications There must be a cause-and-effect relationship between the care provided and the condition, and An indication in the documentation that it is a complication A condition that is normal and expected postoperatively is not a complication

32 Infections Resistance to antimicrobial drugs? Identification of the organism (if possible) HIV and AIDS are not interchangeable Once the patient has developed an HIV related illness the patient will always be assigned AIDS code on every subsequent admission/encounter Neoplasms Expanded code choices including option for overlapping sites Asks for information regarding alcohol and tobacco use, abuse, dependence, exposure to, or history of

33 Diabetes Type? Insulin use? Manifestations? DM due to an underlying condition or induced by drugs or chemicals? We can now code for underdosing as well as overdosing as in the case of an insulin pump malfunction Mental Illness New codes for in remission Codes for pain exclusively related to psychological disorders Wandering in unspecified dementia coded to behavior disturbance Alzheimer s disease Codes expanded to reflect early vs. late onset

34 Headaches Type (Cluster, Vascular, Tension-type, Drug-induced, etc.) Migraines Type (with or without aura, abdominal, common, menstrual, ophthalmoplegic, chronic, triggered seizures, etc.) Include: Refractory, intractable, persistent, with or without cerebral infarction, with or without status migrainosus The following terms to be considered equivalent to intractable: Pharmaco-resistent (pharmacologically resistant) Treatment resistant, refractory (medically) Poorly controlled Eyes Laterality Glaucoma Type Added: suspect, secondary to drugs Cataracts Type (age-related/senile, congenital, diabetic, due to, etc.) Ears Laterality For Otitis Media: Asks for information regarding tobacco use, abuse, dependence, exposure to, or history of Any associated perforated tympanic membrane

35 STEMI or NSTEMI, initial or subsequent? Specify location if known (anterior wall, inferior wall, subsequent transmural [Q wave] MI, etc.) Specify date of previous MI, if applicable Respiratory conditions request detail regarding tobacco use or history of use, or occupational or environmental exposure to Asthma New terms added Mild intermittent Moderate persistent Mild persistent Severe persistent Intrinsic/Extrinsic Pregnant patients (all settings) List trimester / number of weeks gestation Document outcome of delivery (single liveborn, etc.) If pregnancy is considered incidental to the encounter, must be stated as such in the record

36 Glasgow Coma Scale Now can be coded (per category or total) (eye opening, verbal/motor response) State when scale was recorded Unspecified In the field On arrival to ED Hospital admission Injuries Episode of care 24 hours after hospital admission Description A - Initial encounter while patient is receiving active treatment for the condition (Example: surgical treatment, emergency department encounter, evaluation and treatment by new physician) D - Subsequent encounter after patient has received active treatment and is receiving routine care for condition during the healing or recovery phase (Example: cast change or removal, medication adjustment, aftercare following treatment) S - Sequela is for complications or conditions that arise as a direct result of a condition (Example: scar formation after a burn) Acute or Chronic Infection document infectious organism, if known Indicate any retained foreign bodies For sequela, list current condition in addition to the original injury External cause of injury (MVA, fall on stairs, sports, etc.)

37 Fractures Location? Specific anatomical location Laterality? Right, Left, or Bilateral? Phase of treatment/episode of care (Initial, subsequent, sequela) For subsequent: Routine healing Nonunion Delayed healing Malunion Complications? Intraoperative/postprocedural? Pathologic Underlying condition? Neoplastic disease (specify neoplasm)? For patients with Osteoporosis (Specify traumatic or pathologic) Traumatic Fractures Displaced or non-displaced? What type/kind of fracture? (Torus, greenstick, comminuted, etc.) Open or Closed? Open Fractures of forearm, femur, lower leg (including ankle): Gustilo Classification-I, II, IIIA, IIIB, or IIIC Infections? Specify organism, if known Cause of injury (MVA, fall down stairs, etc.)

38 There are special instructions for open fractures of the: Forearm Femur Lower leg, including the ankle The extended 7th character unique to these coding categories based on the Gustilo Classification that uses the amount of energy, the extent of softtissue injury and the extent of contamination to determine the severity, healing, infection, and amputation rates Helps to determine the prognosis for recovery of the patient The classification would ideally be found in the op report

39 Type I II Description Clean wound, wound less than 1 cm, minimal soft tissue injury Wound greater than 1 cm, moderate soft tissue injury Extensive damage to soft tissues, including muscle, skin, and neurovascular structures; includes: Traumatic amputations Fractures over 8 hours old Fractures requiring vascular repair Farm injuries with soil contamination III IIIA IIIB IIIC Type III with adequate soft tissue coverage of fractured bone despite extensive soft tissue laceration or damage Includes severely comminuted fractures Type III with extensive soft tissue lost with periosteal stripping and bony exposure Usually associated with massive contamination Type III with arterial injury requiring repair

40 Physician sees a patient in a subsequent encounter for a non-union of an open fracture of the right distal radius with intra-articular extension and a minimal opening with minimal tissue damage ICD-9 code: Non-union of fracture (no specific code for site) ICD-10 code: S52.571M Other intra-articular fracture of lower end of right radius, subsequent encounter for open fracture type I or II with nonunion

41 Location - Forearm Type of Fracture Displaced or Nondisplaced Laterality Ulna unspecified Torus Displaced Right A - Initial for closed fracture Ulna upper end Greenstick Nondisplaced Left Olecranon process w/o intraarticular extension Olecranon process w/ intraarticular extension Transverse Oblique Unspecified Episode of Care / Open or Closed B - Initial encounter for open fracture type I or II (or open NOS or not otherwise specified) C - Initial encounter for open fracture type IIIA, IIIB, or IIIC D - Subsequent encounter for closed fracture with routine healing Coronoid process Spiral E - Subsequent encounter for open fracture type I or II with routine healing Shaft of Ulna Comminuted F - Subsequent encounter for open fracture type IIIA, IIIB, or IIIC with routine healing Lower end of ulna Segmental G - Subsequent encounter for fracture with delayed healing Ulna styloid process Radius unspecified Monteggia Bent Bone H - Subsequent encounter for open fracture type I or II with delayed healing J - Subsequent encounter for open fracture type IIIA, IIIB, or IIIC with delayed healing Radius upper end Galeazzi K - Subsequent encounter for fracture with nonunion Head of Radius Neck of Radius Colles Smith s M - Subsequent encounter for open fracture type I or II with nonunion N - Subsequent encounter for open fracture type IIIA, IIIB, or IIIC with nonunion Shaft of Radius Barton s P - Subsequent encounter for fracture with malunion Lower end of radius Radial styloid process Extraarticular Intraarticular Q - Subsequent encounter for open fracture type I or II with malunion R - Subsequent encounter for open fracture type IIIA, IIIB, or IIIC with malunion Unspecified fx of forearm S - Sequela

42 Burns - Distinction between burns and corrosions Burns thermal burns from a heat source Corrosions due to chemicals Classified by depth, extent, and agent Poisoning / Underdosing / Adverse Effects Substance (cocaine, penicillin, Tylenol, etc) Overdosing Intent Accidental, intentional self-harm, assault, undetermined Underdosing (that results in a negative health consequence) Condition necessitating care as a result (nausea and vomiting, unconscious, etc.)

43 Diagnosis Description I-9 I-10 Problem Information Needed Arthritis M19.90 Unspecified Code Breast Cancer C50.91 Missing information to code Cataract H26.9 Additional information needed Colon polyps D12.2 Additional information needed Type-infectious, juvenile, meaning osteoarthritis, rheumatoid, etc.? If meaning osteoarthritis, need if generalized, primary, secondary, or post-traumatic? Specific location? Laterality? Specific location, quadrant, or overlapping site. Estrogen receptor status if known. Type (infantile/juvenile, drug induced, senile, anterior, diabetic, presenile, nuclear, traumatic, etc.)? Laterality? Site specific: cecum, ascending, transverse, descending sigmoid, etc. Derangement of medial meniscus M Missing information to code Acute /Chronic is not specified, based on the statement: "having failed conservative management" chronic ICD-9/ICD- 10 was selected. Episode of care is not documented: Initial or subsequent encounter? Or sequela? ESRD N18.6 Additional information needed Need additional information to identify dialysis status Specific anatomical information (which finger, which bone, proximal-shaft-distal)? Displaced or non-displaced? Right, Left, or Bilateral? Episode of care: Initial or subsequent Fractures 816 S62.602A Episode of care not specified encounter? Or sequela? GERD K21.9 Additional information needed With or without esophagitis? With gangrene or obstruction? Unilateral or bilateral? Inguinal hernia K40.90 Additional information needed Recurrent? Osteoarthritis of knee (Degenerative) M17.-- Missing information to code Bilateral or Unilateral? Primary, Secondary? Post-traumatic?

44 If applicable, always state laterality Detail anatomical locations State whether the patient is in the treatment or healing phase (most follow-up visits) or is this a late effect/sequela of an injury? Define the original injury to determine the injury code and define the late effect Example: Thigh pain due to a closed fracture of the shaft of the right femur in an MVA 5 years ago State acute or chronic, old injury, any descriptive conditions that help to illustrate the condition Acute duodenal ulcer with perforation State any due to or precipitating conditions Post-traumatic osteoarthritis, gout due to renal impairment Remember to include comorbid and complicating conditions that impact your decision making

Replaces ICD-9-CM, volume 3 Developed in collaboration between CMS and 3M specifically for the facility reporting of hospital inpatient services The coding guidelines have been approved by the four

46 Replaces ICD-9-CM, volume 3 Developed in collaboration between CMS and 3M specifically for the facility reporting of hospital inpatient services The coding guidelines have been approved by the four organizations that make up the Cooperating Parties for ICD-10-PCS: The American Hospital Association (AHA) The American Health Information Management Association (AHIMA) The Centers for Medicare and Medicaid (CMS) The National Center for Health Statistics (NCHS) The procedure codes have been adopted under HIPAA for the hospital inpatient healthcare settings

47 ICD-9-CM, Volume 3 ICD-10-PCS 3-4 Numeric characters 7 Alphanumeric characters Approximately 4,000 procedure codes ICD-9-CM Approximately 72,000 codes Limited space to add new codes Allows incorporation of new procedures as unique codes with ample room for expandability Terminology lacked clarity Standardized terminology, defines a single meaning for each term used in the system providing clarity and minimizing ambiguity Fixed set of codes available No fixed codes, codes are constructed using different values and tables unique for each substantially different procedure

48 Section Body System Root Operation Body Part Approach Device Qualifier Each character has a specific function in the code structure Section - Determines broad procedure category Body System - General physiologic or anatomic region involved Root Operation - Objective of the procedure (e.g., bypass, removal, resection etc.) Body Part - Specific anatomic site where the procedure was performed Approach - Technique used to reach procedure site Device - Devices that remain after the procedure is completed Qualifier - Additional info about a specific attribute of the procedure (e.g., type of transplant, diagnostic excision [i.e. biopsy] etc.)

49 Section Body System Root Operation Body Part Approach Device Qualifier O 1 D 2 B Z 6 7 Z

If you perform any procedures on an inpatient basis currently: Your procedures and diagnosis codes combine to determine the DRG (Diagnosis-Related Group) that, in turn, determines the reimbursement

50 If you perform any procedures on an inpatient basis currently: Your procedures and diagnosis codes combine to determine the DRG (Diagnosis-Related Group) that, in turn, determines the reimbursement for the supplies and services a patient typically receives for a type of hospital inpatient stay With the implementation of ICD-10-CM/PCS, more detail will be obtainable to more fully describe the procedure you perform and the medical necessity for the treatment for which you are requesting reimbursement

54 Now that you know more about ICD-10-CM, what comes next? Auditing you will be given a report card with information specific to documentation and specialties in relation to ICD-10 needs Specialty crosswalks We have put together a number of ICD-9 to ICD-10 crosswalks with the most often used codes We have created Quick Reference tools to help see, at a glance, the additional information needed in your documentation Practice makes perfect! We suggest that you begin now to look at your documentation with a more critical eye. Does it contain the elements necessary to accurately code, avoid delays in submitting, and getting payment for your services?

abeocoder FREE Coding App - ICD-10 Codes &

ASA Codes - Search by Keyword - Search by

Reference Download FREE on ios, Android and

abeocoder.com - Send questions to info@abeo.

Other Available Features*: - Anesthetic Drug

56 abeocoder FREE Coding App - ICD-10 Codes & Descriptions - CPT Codes & Descriptions - Anesthesia ASA Codes - Search by Keyword - Search by Category/Body Systems - Save Favorites for Easy Reference Download FREE on ios, Android and BlackBerry Devices: - Visit your App store - Or go to abeocoder.com - Send questions to info@abeo.com Coming soon to iwatch! Other Available Features*: - Anesthetic Drug Calculator for Adult/Pediatric - Average Billable Time by Minutes & Units * Available by subscription, $24.99/year, annual renewal.

57 Questions? Ladonna Schaad, CCS-P, CPC, CANPC abeo Management Corporation Coding Compliance Manager

58 CMS Quick Reference Information CMS ICD-10 It s closer than it seems, How Will ICD-10 Affect Clinical Documentation ICD-10 Basics for Medical Practices ICD-10-CM Official Guidelines for Coding and Reporting International Classification of Diseases, Tenth Revision, Clinical Modification (ICD-10-CM AMA Preparing for the ICD-10 Code Set

ICD-10 Service Line Overview Musculoskeletal

ICD-10 Service Line Overview Musculoskeletal ICD-10 incorporates much greater clinical detail and specificity as well as updated terminology to be consistent with current clinical practices. ICD-10-CM